System, method and apparatus for real-time access to networked radiology data

ABSTRACT

A system and method for secure HIPPA complaint data access by a health professional particularly related to radiology data, such as DICOM images and the like are provided. Including a method for viewing DICOM images as part of a real-time virtual medical consultation using at least one DICOM viewer may have a DICOM viewer option within a secure telemedicine platform; supplying a remote DICOM image database linked to a patient record; providing choices so that a medical professional has the ability to choose a of DICOM image such as a synchronous review, an asynchronous review, an image review, a video review, and a stacked series review; and transferring an encrypted DICOM image to the medical professional based on the selected image choice. According to one approach, the method and system may also have the step of providing concurrent videoconferencing capability between a caller and a callee using WebRTC functionality.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Patent ApplicationNo. 61/369,461, filed Jul. 30, 2010, U.S. Non-provisional patentapplication Ser. No. 13/165,052, filed Jun. 21, 2011, U.S.Non-provisional patent application Ser. No. 15/158,007, filed May 18,2016, and U.S. Non-provisional patent application Ser. No. 15/784,876,filed Oct. 16, 2017, the contents of each of which are herebyincorporated by reference in their entirety.

FIELD

The disclosure generally relates to remote medical diagnostic andmonitoring systems and solutions in which a physician conducts anexamination of a remotely located patient, and more specifically, to asystem and method for providing a second opinion option and biosensormonitoring.

BACKGROUND

Access to medical care providers remains a challenge for many patientpopulations, both due to cost and lack of geographic proximity. Patientpopulations in rural areas, especially those in third world countries,will likely find themselves without adequate numbers of local treatingphysicians for decades to come. Many patients are house-bound and cannoteasily travel to a medical clinic. In addition, certain types ofspecialists (e.g., neurologists) are often in short supply, leaving somepatient populations underserved.

Telemedicine systems have been proposed as a way of remotely diagnosingand treating patients using telephonic communications. However, knownsystems typically suffer from several drawbacks. First, many of themlack adequate safeguards to protect the confidentiality of patientmedical information. In the United States, the Health InsurancePortability and Accountability Act of 1996 (“HIPAA”) requires entitiesexchanging health care information to enact appropriate safeguards toprotect the confidentiality of electronically transmitted patientinformation. Many prior telemedicine systems do not allow patients andphysicians to communicate in real time in a manner that protects theircommunications from third parties.

In addition, many known telemedicine systems lack a mechanism forconveniently and securely transmitting patient information, such as realtime access to networked/remote radiology images and even simultaneousvideoconferencing related to such images. Thus, a need has arisen for asystem and method for secure HIPPA complaint data access by a healthprofessional particularly related to radiology data, such as DICOMimages and the like which address the foregoing issues.

SUMMARY

Embodiment for a system and method for secure HIPPA complaint dataaccess by a health professional particularly related to radiology data,such as DICOM images and the like are disclosed herein. In one suchembodiment, a method for viewing DICOM images as part of a real-timevirtual medical consultation using at least one DICOM viewer may havethe steps of providing a DICOM viewer option within a securetelemedicine platform; supplying a remote DICOM image database linked toa patient record; providing choices so that a medical professional hasthe ability to choose which type of DICOM image they desire or need,wherein the choices are selected from a list consisting of a synchronousreview, an asynchronous review, an image review, a video review, and astacked series review; and transferring an encrypted DICOM image to themedical professional based on the selected image choice.

According to one approach, the method may also have the step ofproviding concurrent videoconferencing capability between a caller and acallee using WebRTC functionality.

According to another approach, an apparatus for receiving real-timepatient DICOM images as part of a HIPPA compliant telemedicine platform,can be provided having a memory; at least one processor configured toexecute instructions stored in the memory to: receive an image generatedfrom at least one DICOM database; transmit over a network to a firstremote server at least a portion of the DICOM image information and atleast a portion of the patient identification data.

According to one approach the apparatus image from the DICOM databasecan be transmitted to the apparatus via one of a wireless connection anda wired connection. According to another approach, the image istransmitted with a concurrent videoconference between a caller and acallee using WebRTC functionality.

Other aspects and features of the embodiments herein will becomeapparent to those ordinarily skilled in the art upon review of thefollowing description of specific embodiments in conjunction with theaccompanying figures.

BRIEF DESCRIPTION OF THE DRAWINGS

Referring now to the drawings, illustrative embodiments are shown indetail. Although the drawings represent some embodiments, the drawingsare not necessarily to scale and certain features may be exaggerated,removed, or partially sectioned to better illustrate and explain thepresent invention. Further, the embodiments set forth herein areexemplary and are not intended to be exhaustive or otherwise limit orrestrict the claims to the precise forms and configurations shown in thedrawings and disclosed in the following detailed description.

FIG. 1 is a diagram of a system for performing virtual medicalexaminations in accordance with one embodiment;

FIG. 2 is a schematic diagram of a patient device or a physician deviceused in the system of FIG. 1;

FIG. 3 is a schematic diagram of an exemplary diagnostic device for usein the system of FIG. 1;

FIGS. 4A, 4B, 4C and 4D are an exemplary graphical user interfacescreens on the patient device of FIG. 2;

FIG. 5 is a flowchart diagram depicting an exemplary method ofgenerating patient diagnostic information and securely transmitting andstoring the data in a patient records server,

FIG. 6 is a flowchart diagram depicting an exemplary method of securelyretrieving patient diagnostic information from a patient records serverand displaying the retrieved data on a physician device; and

FIG. 7 is a flowchart depicting an exemplary method of performing avirtual medical examination.

FIG. 8 illustrates an exemplary system for use in implementing methods,techniques, devices, apparatuses, systems, servers, sources and thelike, in accordance with some of the present embodiments.

FIG. 9 illustrates an exemplary system for use in implementing methods,techniques, devices, apparatuses, systems, servers, sources and thelike, in accordance with another approach of the present embodiments.

FIG. 10 illustrates an exemplary system for use in implementing methods,techniques, devices, apparatuses, systems, servers, sources and thelike, in accordance with another approach of the present embodiments.

FIG. 11 illustrates an exemplary system for use in implementing methods,techniques, devices, apparatuses, systems, servers, sources and thelike, in accordance with another approach of the present embodiments.

FIG. 12 illustrates an exemplary system for use in implementing methods,techniques, devices, apparatuses, systems, servers, sources and thelike, in accordance with some of the present embodiments.

FIGS. 13A, 13B and 13C are a flowchart depicting an exemplary system andmethod for a patient to access a consult and a second opinion consult.

FIG. 14 illustrates an exemplary system and method for use inimplementing methods, techniques, devices, apparatuses, systems,servers, sources and the like, in accordance with some of the presentembodiments detailing input from a patient's biosensors.

FIG. 15 illustrates an exemplary Login in screen to access an exemplaryapplication to view DICOM records and the like.

FIG. 16 illustrates an exemplary homepage for the application to viewDICOM records and the like of FIG. 15 defaulting to the “Query andRetrieve” tab.

FIG. 17 illustrates an exemplary view for the homepage of FIG. 16 toview DICOM records when the “Store/Upload” tab is selected.

FIG. 18 illustrates an exemplary view for the homepage of FIG. 16 toview DICOM records when the “Viewer” tab is selected.

FIG. 19 illustrates an exemplary schematic view of a selected DICOMrecord selected from DICOM list of FIG. 18.

FIG. 20 illustrates an alternate exemplary schematic view of a selectedDICOM record selected from DICOM list of FIG. 19 and the ‘Stack Scroll’button is selected.

FIG. 21 illustrates an alternate exemplary Login in screen with agraphical user interface screen to access an exemplary applicationsincluding an application to view DICOM records and the like.

FIG. 22 illustrates the graphical user interface screen of FIG. 21showing an exemplary schematic view of a selected DICOM record selectedfrom a patient specific DICOM list.

FIG. 23 illustrates an exemplary schematic of an optional videoconferencing capability within the DICOM viewer application.

DETAILED DESCRIPTION

Described herein are systems, methods and apparatuses for performingvirtual medical examinations. The systems, methods and apparatusesgenerally involve the secure transmission of patient diagnosticinformation by a patient remotely located from a treating physician andthe secure retrieval and viewing of the data by the physician. Thesystems, methods and apparatuses also generally involve securevideoconferencing to allow the physician to remotely conduct a medicalexamination in real-time, thereby allowing the physician to providehealth instruction information by, for example directing theexamination, providing therapeutic instructions and any otherinstructions to the patient.

Referring to FIG. 1, a virtual medical examination system 20 isdepicted. The system can include one or more diagnostic devices 32 thatare configured to generate patient diagnostic information, a remotepatient device 36, a physician device or healthcare provider device 38,a patient records server 40, a videoconferencing server 42 and a remotecontent manager server 44. Diagnostic devices 32, remote patient device36, physician device 38, patient records server 40, videoconferencingserver 42 and remote content manager server 44 can all be connectedeither directly or indirectly via a network 50.

Remote patient device 36, physician device 38, patient records server40, videoconferencing server 42 and remote content manager server 44 mayeach be a computer having an internal configuration of hardwareincluding a processor such as a central processing unit (CPU) and amemory. Accordingly, remote patient device 36 can have a CPU 36 a and amemory 36 b, physician device 38 can have a CPU 38 a and a memory 38 b,patient records server 40 can have a CPU 40 a and a memory 40 b,videoconferencing server 42 can have a CPU 42 a and a memory 42 b andremote content manager server 44 can have a CPU 44 a and a memory 44 b.CPUs 36 a, 38 a, 40 a, 42 a and 44 a can be a controller for controllingthe operations of patient device 36, physician device 38, patientrecords server 40, videoconferencing server 42 and remote contentmanager server 44, respectively. CPUs 36 a, 38 a, 40 a, 42 a and 44 acan each be connected to memories 36 b, 38 b, 40 b, 42 b and 44 b,respectively, by, for example, a memory bus. Memories 36 b, 38 b, 40 b,42 b and 44 b can store data and program instructions which are used byCPUs 36 a, 38 a, 40 a, 42 a and 44 a, respectively. Other suitableimplementations of patient device 36, physician device 38, patientrecords server 40, videoconferencing server 42 and remote contentmanager server 44 are possible. For example, in one embodiment, patientrecords server 40, videoconferencing server 42 and remote contentmanager server 44 can be integrated into one server.

Exemplary diagnostic devices 32 include electrocardiographs (ECG), pulseoximeters, blood pressure cuff, spirometers, sphygmomanometers, weightscales, stethoscopes, blood chemistry analyzers, microscopes,ultrasounds probes, glucometers, horoscope, PT/INR, medication station,and the like. In clinic or visiting nurse peripherals can includeabdominal probes, vascular access probes, endocavity probes, opthamologyprobe, proscope, thermometer, remotely controlled 360 degree highdefinition cameras, and the like. The diagnostic devices 32 can includea patient diagnostic information wireless transmitter for transmittingpatient diagnostic information to a remote patient device 36.Communications between diagnostic devices 32 and patient device 36 canbe wired and/or wireless.

Wireless communications between diagnostic devices 32 and patient device36 may be provided using various protocols and other wirelesstechnologies, including 3G and 4G wireless technologies and the IEEEseries of wireless technologies. More particularly, wirelesscommunications may take place over a CDMA, EDGE, EV-DO, GPRS, GSM, UMTS,W-CDMA, or a 1×RTT network as well as an IEEE 802.11 (WIFi), 802.15(Bluetooth and Zigbee), 802.16 (WiMax) or 802.20 (MBWA) network. In theexample shown in FIG. 1, wireless communications diagnostic devices 32and patient devices 36 will take place using Bluetooth technology, butthe embodiments disclosed herein are not to be limited to Bluetooth.

Bluetooth communications have certain features that can be beneficial inmany implementations of system 20, including a lack of wires, securityfeatures such as secure simple device pairing and adaptive frequencyhopping, and an effective device to device transmission range of up toabout 300 feet. Using the Bluetooth protocol, suitable diagnosticdevices 32 can be identified and paired with the remote patient workstations 36. Suitable Bluetooth-enabled diagnostic devices 32 can besupplied by QRS Diagnostics of Plymouth, Minn.

In other embodiments, rather than communications between diagnosticdevices 32 and patient device 36 occurring directly, communications mayoccur directly via, for example, a local wireless signal gateway (notshown). The wireless signal gateway can be connected to network 50 andis generally in close proximity to diagnostic devices 32 at the time oftheir transmission of diagnostic information. In one embodiment, thewireless signal gateway is a Bluetooth-enabled wireless signal gatewaythat may operate external to the patient device 36 hardware as aseparate entity or can be integrated into patient devices 36 to allowfor long-range transmission of patient diagnostic information to aninternet server (not separately shown in FIG. 1), and ultimately, topatient records server 40. One suitable Bluetooth internet gateway thatmay be used is the Gigaset-One Bluetooth Gateway supplied by Siemens,and the like such as a gateway sold under the tradename DELL or INTEL.

When communication between diagnostic device 32 and patient device 36 isvia a wireless protocol, diagnostic device 32 and patient device 32 canbe within a suitable distance from one another to permit communication.For example, in one embodiment, diagnostic device 32 and patient device32 are no more than 90 feet one another although other suitabledistances are possible. Because diagnostic devices 32 have a relativelylimited transmission radius, the transmission of patient diagnosticinformation from diagnostic devices 32 to patient devices 36 need not beencrypted. However, patient diagnostic information transmitted fromdiagnostic devices 32 to patient records server 40 can be encrypted toprevent undesired access by other users of network 50. One encryptionmethod includes https (hypertext transfer protocol secure). However,other encryption methods may be used. In one embodiment, wirelesssignals can secured via unique user identifiers for patient diagnosticperipheral devices 32.

In one implementation, the diagnostic devices 32 and patient devices 36utilize the Bluetooth Health Device Profile for transmitting medicaldata. The Bluetooth Health Device Profile has been standardized byBluetooth SIG, the industrial association for Bluetooth manufacturers.The Health Device Profile enables a range of additional functions suchas exact chronological synchronization of several Bluetooth connectedmedical sensors or the option of transferring different medical data inparallel via a Bluetooth interface which is necessary when severaldiagnostic devices generate patient diagnostic informationsimultaneously. The Health Device Profile consists of one part thatspecifies transfer protocols used for medical data in the Bluetoothstack and another part that describes the structure of the actualmedical data.

Patient records server 40 is connected to network 50 and can include anumber of patient data files stored in a computerized database. Thefiles may be organized by a variety of methods. However, in oneimplementation, each patient's files are associated with patientidentification data, which can be a unique identifier, such as a numericor alphanumeric identifier. The patient identifier allows a physician orany other health care provider (e.g. nurse, health care administrator,pharmacist surgeon etc.) to retrieve specific data for a desiredpatient. Patient diagnostic information transmitted from diagnosticdevices 32 can be transmitted in association with a patient identifierso that patient diagnostic information received by patient recordsserver 40 is associated with the specific patient for whom thediagnostic data was generated.

Network 50 may take a variety of forms such as a local area network,wide area network, or the Internet. When network 50 is, for example, theInternet medical examinations can be conducted between physicians andpatients who are geographically situated at long distances from oneanother. In the case where network 50 is the internet, patient recordsserver 40 is referred to as a patient records internet server. In suchcases, patient records internet server 40 can be assigned a uniqueinternet protocol address to which wireless signal transmissions frompatient device 36 are directed when patient diagnostic information isgenerated by diagnostic devices 32.

Additionally, other networks can be interfaced with or completelyreplace network 50. For example, when physician device 38 is a handhelddevice such as a mobile phone, PDA, smart phone or any other suitablehandheld device, network 50 can be a mobile communications network andcan include one or more base stations (e.g. macrocell, femtocell,microcell, picocell, etc.). Physician device 38 can send communicationsto network 50 via the mobile communications network or othertransmitting/receiving tower. For example, radio waves can be used totransfer signals between physician device 38 through one or more basestations in the mobile communications network, which can them transmitthe communications to network 50. Physician device 38 may alsocommunicate in any other suitable manner For example, in one embodiment,physician device may communicate via satellite. Further, for example,physician device 38 can connect directly to network 50 (e.g. via 3 g or4 g services).

When physician device 38 is a handheld device, it can include asubscriber identity module (SIM) card, which can be equipped withencryption/decryption programming. This encryption/decryptionprogramming can be used to authenticate the handheld device and can bein addition to the encryption and decryption of diagnostic informationand health instruction information as will be discussed in more detailbelow. In some embodiments, the SIM card can be used to perform theencryption/decryption of the diagnostic information and healthinstruction information.

The SIM card can be in a form that is removable by the user, which canmake it possible to carry mobile subscription information and datathrough different types and generations of handheld devices.Alternatively, the SIM card can be integrated into the handheld device.The SIM card can, for example, contain a microchip that houses aprocessor (e.g. microprocessor) and a memory. The memory can haveinstructions stored thereon, that when executed by the processor encryptvoice and data transmissions, which can assist in preventing thirdparties from intercepting transmissions. The SIM, as discussedpreviously, can identify the user to the mobile communications networkas a legitimate user. Each SIM card can be equipped with an additionalmemory such as EEPROM (Electrically Erasable Programmable Read-OnlyMemory), which can contain additional information about the device. Forexample, EEPROM can store an IMSI (International Mobile SubscriberIdentification), a PIN (Personal Identification Number), aninternational access entitlement, a priority class, and subscriberinformation.

As indicated in FIG. 1, virtual medical examination system 20 includes aphysician device 38, which can be a hand-held computing device with avisual display. Device 38 can be programmed to allow the physician toaccess, retrieve, decrypt, and view patient diagnostic information frompatient records server 40. Device 38 can be connected to network 50. Inone embodiment, physician device 38 is wirelessly connected to theinternet and configured to generate the IP address of patient recordserver 40 for the retrieval of patient diagnostic information. Physiciandevice 38 can also be programmed to decrypt patient diagnosticinformation received from patient records server 40 via network 50 sothe data can be displayed on physician device 38. Thus, the networkingof physician device 38 with patient records server 40 and diagnosticdevices 32 allows for the secure transmission of patient diagnosticinformation to patient record server 40 and the secure retrieval ofpatient diagnostic information from patient record server 40 by aphysician. Patient record server 40 may be programmed to require one ormore passwords or other sign-in credentials to verify the identity ofthe physician and ensure that access to patient diagnostic informationis appropriately limited to authorized individuals. The transmission ofpatient diagnostic information to patient records server 40 and thesubsequent retrieval of the data from patient records server 40 by aphysician can occur in real-time.

Virtual medical examination system 20 can also be configured to allow apatient and physician to conduct video conference calls. In oneimplementation, system 20 is configured to allow a patient and physicianto conduct secure, encrypted video conference calls that cannot bemonitored or accessed by unauthorized third parties. In one example, theencryption provides for HIPAA compliant transmission of patientinformation. In another implementation, multiple authorized parties mayparticipate in the video conference calls, thereby allowing multiplephysicians (who may be remote from one another and from the patient) tocollaborate and/or jointly conduct an examination of the patient.

In the illustrative example of FIG. 1, a videoconferencing server 42 isprovided which allows a patient and physician to conduct a secureencrypted video conference call over network 50. A “secure”videoconference server includes features that prevent or minimize thelikelihood that third parties will be able to intercept informationtransmitted from one party to another during the videoconference. Suchinterception is sometimes referred to as a “man in the middle attack” or“packet sniffing.” In some embodiments, network 50 is the Internet, inwhich case the videoconferencing server 42 may be referred to as avideoconferencing internet server. In one embodiment, the patient speaksinto a microphone (which may be provided on device 36), and stands inthe field of view of a camera (which may also be provided on device 36)to generate voice and video data. The voice and video data is encrypted,for example by using https, and transmitted to video conferencing server42 via network 50. Https can create a secure channel over an unsecurenetwork, such as the internet. The trust inherent in HTTPS is based onmajor certificate authorities which come pre-installed in browsersoftware, which allows users to confirm the security of the connectionif (1) the user trusts that their browser software correctly implementsHTTPS with correctly pre-installed certificate authorities; (2) the usertrusts the certificate authority to vouch only for legitimate websiteswithout misleading names; (3) the website provides a valid certificate(an invalid certificate shows a warning in most browsers), which meansit was signed by a trusted authority; (4) the certificate correctlyidentifies the website; and (5) either the intervening hops on theInternet are trustworthy, or the user trusts that the protocol'sencryption layer (TLS or SSL) is unbreakable by an eavesdropper.

A physician can use device 38 to receive voice and video data from thepatient. The voice and video data is transmitted in encrypted form, fromvideoconferencing server 42 to device 38. Device 38 includes a displayscreen for viewing video images of the patient and a speaker forlistening to voice communications from the patient. The physician speaksinto a microphone (which may be provided on device 38) and stands in thefield of view of a camera (which may also be provided on device 38) togenerate voice and video data. The voice and video data are encrypted bydevice 38 and transmitted to video conferencing server 42 via network50. The encrypted voice and video data is then received and decrypted bypatient device 36 via network 50. Patient device 36 can include a visualdisplay for viewing images of the physician and a speaker for listeningto voice communications from the physician.

Videoconferencing server 42 can be a computer server that is connectedto network 50. Video conferencing server 42 can be a video conferencinginternet server, as in the case where network 50 is the internet.Suitable servers are supplied by Visual Systems Group, Inc., RadvisionLtd., and Tandberg. In one embodiment, a video conference call between apatient and physician is conducted using a single, secured TCPIIPconnection. In another embodiment, videoconferencing server 42 isconfigured to allow multiple parties to participate in a secure virtualmedical examination. This option is particularly useful for situationsin which a primary physician and a secondary physician (e.g., aconsultant or specialist) are geographically remote from one another andfrom the patient. In one example, a virtual conference room is providedwhich allows for a multi-participant secure meeting. In this manner,virtual medical examination system 20 allows for multi-physician medicalexaminations and real-time consultations which previously may have beencost prohibitive or otherwise infeasible.

In certain implementations, video conferencing server 42 is configuredas a plurality of geographically distributed video conferencing serversthat are interconnected via the internet. The use of distributed videoconferencing servers allows for load balancing of the various servers tomaintain optimum performance. Video conferencing server 42 can beconfigured to require users to provide passwords or other evidence oftheir authorization to participate in a video conference to betterensure that the confidentiality of patient information is notcompromised. In one embodiment, videoconferencing server 42 is asession-initiation protocol (“SIP”) server. Other protocols forestablishing video conferencing are also available. For example, videoconferencing can be established using IP Multimedia Subsystem (IMS),Media Gateway Control Protocol, Real-Time Transport Protocol (RTP) orany other suitable protocol.

In one embodiment, patient device 36 and physician device 38 receivetheir content from a remote content manager server 44 connected tonetwork 50. In one embodiment, when devices 36 and 38 are activated,they retrieve programs that launch graphical user interfaces fromcontent manager server 44 via network 50. This allows for thecentralized updating of the software and interfaces used by the devices36 and 38 and avoids the necessity of individually revising the softwareused in devices 36 and 38. In one embodiment, network 50 is theInternet, in which case content manager server 44 may be referred to asa content manager internet server. In other embodiments, content managerserver 44 supplies devices 36 and 38 with one or more programs thatprovide a common platform to facilitate that receipt, transmission, anddisplay of patient data and patient/physician voice and video data.Patient device 36 and physician device 38 may take a variety of forms,such as a standard personal computer, tablet computer, smartphone, etc.In one embodiment, patient device 36 and physician device 38 include avisual display, a camera, and a speaker and patient navigation viascreen-displayed icons.

In one embodiment, devices 36 and 38 are handheld computing devices suchmobile phones, PDAs, smartphones, tablets, notebooks, computers,netbooks or any other suitable communication device. One suitable typeof patient device 36 or physician device 38 is, for example, 10.4″Intel® Atom™ N450 Portable Medical PC. Other suitable devices of varyingsize and architecture are available. For example, a 17″ Portable MedicalPC can be used in lieu of the 10.4″ Portable Medical PC. Another type ofsuitable device includes a TFT (thin film transistor) LCD resistivetouch screen display and an integrated Bluetooth-enabled wirelesstransmitter. Another suitable patient device 36 or physician device 38includes an integrated Bluetooth module, a 2.0 Megapixel CMOS camera,and a 12 Active Matrix Panel resistive touch screen visual display. Italso includes a bar code scanner that facilitates the reading of patientidentification information from bar codes.

Referring to FIG. 2, an exemplary patient device 36 is shown, which alsomay also be used as a physician device 38. Patient device 36 includes avisual display 52 which can include a touch screen. Plastic side grips54 are provided to facilitate hand gripping of device 36. Visual display52 may include a screen with one or more icons 58 that allow the user toinitiate various operations. For example, icons 58 can include a collectpatient diagnostic information icon 58 a, an initiation of a videoconference call 58 b, a return to home icon 58 c, a help icon 58 d, aninternet icon 58 e (i.e. to access the Internet), a shopping cart icon58 f (i.e. to purchase items and/or services) and a health recordinformation icon 58 g to view current and historical patient diagnosticinformation. Other icons are also possible. Speaker 56 is provided toreceive voice communications from a physician, and buttons 60 areprovided to allow the user to initiate operations (in addition to orinstead of graphical icons 58).

During certain examinations, it may be desirable to transmit images of apatient's body to the treating physician. In certain cases, a cameramounted on or integrally provided with device 36 may be sufficient togenerate the necessary images. In other cases, however, it may bedesirable to obtain and transmit magnified images to the physician.Thus, in certain embodiments, diagnostic devices 32 include a digitalmicroscope 62, as shown in FIG. 3. Digital microscope 62 can include alens section 64 and a handle 66. Digital microscope 62 can also includea wireless transmitter, which is Bluetooth-enabled. Thus, in certainembodiments, digital microscope images generated by digital microscope62 can be received and encrypted by device 36 and transmitted tovideoconferencing server 42. The images can be then received fromvideoconferencing server 42 and decrypted by physician device 36 fordisplay thereon. A separate recording server may also be provided torecord the digital microscope images (or any other transmission from thevideo conference call) for subsequent storage in patient records server40. Alternatively, the digital microscope images can be stored directlyin patient records server 40. In accordance with one example, thespecific patient-physician video and voice communications from a videoconference may be stored with the patients medical records in patientrecords server 40 for subsequent retrieval and review, thereby providingan accurate history of patient-physician communications.

As mentioned previously, patient device 36 and physician device 38 caninclude a graphical user interface (GUI) supplied by, for example,content manager server 44 which facilitates the initiation of desiredfunctions. Referring to FIGS. 4A-D, exemplary GUI screen from patientdevice 36 and/or physician device 38 are shown.

FIG. 4A is a screen 68 a on patient device 36 presented to a patient whohas selected the collect patient diagnostic information icon 58 a. Whencollect patient diagnostic information icon 58 a is selected, thepatient is presented with one or more selectable touch screen buttons sothat patient device 36 can identify that a diagnostic procedure will beperformed by the patient using diagnostic device 32. In this example,the patient is presented with the option to take their blood pressure byselecting button 70 a, take their blood glucose by selecting button 70b, their ECG by selecting button 70 c, their weight by selecting button70 d, their pulse/oxy by selecting button 70 e or their spirometerreading by selecting button 70 f. Each button can receive patientdiagnostic information specific to the diagnostic procedure beingperformed. In some instances, alterative or more or less diagnosticprocedures can be displayed to the patient on screen 68 a.

FIG. 4B is a screen 68 b on patient device 36 presented to a patient whohas selected the health record information icon 58 g. When the healthrecord information icon 58 g is selected the patient is able to viewcurrent or historical data related to the diagnostic procedures thathave been performed using diagnostic devices 32. For example, screen 68b includes patient data 78 such as name, birthday, height, weight, etc.,height, weight. Screen 68 b also includes trend data for the patientshowing developments for, for example, height, weight and bmi trend data80 or blood pressure trend data 82. Patient can also view alerts 84related to his/her health. For example, if the patient has abnormallyhigh blood pressure, the alert can indicate that the patient shouldimmediately contact a hospital. Other configurations of screen 68 b arealso possible.

FIG. 4C is a screen 68 c on patient device 36 presented to a patient whohas selected the initiation of a video conference call 58 b. In this isa graphical user interface screen that allows the user to place a videoconference call with a specific doctor conference rooms by selecting oneof touch screen buttons 90 or to enter one or more general conferencerooms by selecting one of touch screen buttons 92. A similar screen canalso be presented on physician device 36. Accordingly, the patientand/or doctor(s) can conduct a video conference if both have entered thesame conference room. Communications via the patient and doctor (orbetween doctors), as discussed previously, is encrypted and secure.

Alternatively to having conference rooms, or in addition, screen 68 caninclude a key pad section, an icon section, and a speed dial section.The key pad section includes phone button images that can allow thepatient to key in the telephone number of the doctor participating inthe video conference call. The speed dial section can allow the user topre-program the phone numbers of selected doctors and to associate adesignated “button” with each doctor to provide one-touch dialing. Theicon section can include various icons that allow a user to initiatedesired operations such as calling 911, accessing a phone directory,initiating video for a video call, taking diagnostic data with adiagnostic device 32, accessing a medical supplies web site to purchasesupplies, and accessing health care information.

Once a video conference room has been selected, the patient (or doctor)can be presented with a screen 68 d illustrated in FIG. 4D showing apatient and/or physician device conducting a video conference. Inaccordance with the example, screen 69 includes an icon section 102, anda plurality of video display sections, such as first video displaysection 104 and a second video display section 106. Video displaysections 104 and 106 can display video images of different videoconference participants. For example, for patient device 36, videodisplay section 104 may display the primary treating physician, andvideo display section 106 may display a consulting physician orspecialist. In addition, video display section 104 may be used toprovide the patient with a video image of himself as generated by acamera on device 36. For a physician device 38, video display section104 may be used to display the image of the patient generated by acamera located on patient device 36 while video display section 106 maybe used to display the image of the patient generated by digitalmicroscope 62. In one embodiment, a GUI screen is provided which allowsthe physician and/or patient to view video images and patient diagnosticinformation simultaneously.

Device 36 can also have screens displaying tutorials or advertisementsrelated to diagnostic devices 32. For example, in one embodiment, theGUI on device 36 can display tutorial information for aid in using thediagnostic device so that the patient is able to properly transmit theinformation to system 20. They tutorial may be interactive ornon-interactive. In an interactive tutorial, the tutorial may prompt theuser to indicate when they have performed a certain action. Thefollowing are exemplary prompts for blood pressure tutorial using asphygmomanometer device and the prompts that the patient will encounter.

1. Put on cuff, left arm, with pressurizing hose at crook of elbow.

2. Press Power button on 2-in-1; cuff will inflate and slowly deflate.

3. When blood pressure reading shows on screen, press “Blood Pressure”icon.

4. Data will transfer and blood pressure device powers off, and“Successful” message appears on your patient device.

The patient can verify once they have performed a one of the actions.Other tutorials are possible.

Device 36 can also be used to generate advertisements to the patient.For example, if it is determined that the patient's blood glucose levelis too high, an advertisement for a blood glucose medication can begenerated for display on the device's GUI. They advertisements may berun when device 36 is powered on, periodically when device 36 isrunning, prior to device 36 shutting down or at any other suitable time.They devices may or may not be tailored specific to the patient. Theadvertisements may change over time by, for example, an update from thecontent manager server 42. Alternatively, the advertisements can bepre-programmed into device 36 when, for example, the patient receivesdevice 36.

Referring to FIG. 5, a method of using virtual medical examinationsystem 20 to generate and securely transmit patient diagnosticinformation to patient records server 40 will now be described. Inaccordance with the method, a patient selects one or more diagnosticdevices 32 of the type described previously. In step 1002, the patientuses the diagnostic device 32 to generate diagnostic data (e.g., bloodpressure, blood chemistry, pulse oximetry, weight, spirometry, etc.).Diagnostic device 32 transmits (wirelessly or via a wired connection)patient diagnostic information to patient device 36.

In step 1004, patient device 36 encrypts patient diagnostic informationand information identifying the patient (hereinafter patientidentification data) using an encryption protocol such as https. Patientdevice 36 then transmits the encrypted data to patient record server 44via network 50, which can be the internet or any other communicationnetwork. Patient record server 40 can have a unique network address(e.g., IP address), that allows the patient device 36 to uniquelyidentify it as the intended recipient of the encrypted patientdiagnostic information and patient identification data. The patientrecord server 40 stores the patient diagnostic information inassociation with the patient identification data so that the data isaccurately identified with the correct patient when retrieved by ahealth care provider. When the connection between patient device 36 anddiagnostic device 32 is wireless, patient can beneficially performdiagnostic tests without having to make a wired connection to thediagnostic device 32 and a computer or other transmitting device.Instead, the patient need only activate the diagnostic device 32 andlocate it within the zone of transmission of the patient device 32.

In certain examples, diagnostic devices 32 are pre-configured togenerate wireless signals comprising patient identification data thatcorresponds to a specific patient to which diagnostic devices 32 havebeen uniquely assigned. For example, each patient may be assigned aunique numeric or alphanumeric code, which corresponds to a particularwireless signal generated by diagnostic devices 32. In one example, thepatient files resident in patient record server 40 are setup via theweb. When subsequent diagnostics are taken they are applied to the fileby opening the utility ready for the diagnostic information to becaptured.

Referring to FIG. 6, a method of securely retrieving patient diagnosticinformation from patient record server 40 is described. In accordancewith the method, a physician can enter patient identificationinformation into physician device 38 such as by using touch screen 52)at step 1012. Next, at step 1012, physician device 38 can transmit (viaa wired or wireless connection) the patient identification informationto patient record server 40 via network 50. Patient record server 40 cancause a graphical user interface to be displayed on physician device 38which requests certain physician credential information (e.g., a log-inname and a password). Patient record server 40 may be physicallyresident at a facility such a hospital or clinic with which thephysician is associated, although the physician may be remotely locatedfrom server 40 when accessing it. Alternatively, the physician may signinto patient record server 40 before transmitting patient identificationdata to it.

Once the physician's authorization to review data for a specific patientis confirmed, the data is transmitted in encrypted form to physiciandevice 38. At step 1016, physician device 38 can include executable code(which may be provided by content manager server 44) to allow for thedecrypting of encrypted patient diagnostic information. The patientdiagnostic information can then be display on physician device 38 to beviewed by the physician at step 1018.

Referring to FIG. 7, an exemplary method of performing a virtual medicalexamination of a remotely located patient is described. In step 1022,the patient initiates a video conference call using patient device 36 asdescribed previously. A conference call is then initiated withvideoconferencing server 42. Videoconferencing server 42 transmits datato physician device 38 indicating that a call has been initiated. Thepatient may then use an icon in icon section 58 to activate a camera onpatient device 36 and begin the transmission of encrypted patient videodata to videoconferencing server 42.

In step 1024, the physician answers the patient's call by pressingappropriate virtual or physical keys on physician device 38. In certainexamples, the patient receives video images from a camera on thephysician device 38 in video display section 76 and sees the video datagenerated by a camera on patient device 36 in video display section 77.Correspondingly, the physician may see video images generated by thecamera on patient device 36 in video display section 76 of physiciandevice 38 and video images of herself in video display section 77.

In certain examples, the patient may be at his or her home during thevirtual medical examination. In other examples, the patient may be aloneduring the examination. In additional examples, the patient may be withanother individual who can assist in the performance of the examination.In one scenario, the patient is in a clinic or hospital and is assistedby a local health care assistant (e.g., nurse or doctor) in providingthe remote physician with the diagnostic data necessary to develop atreatment plan. After taking a verbal medical history from the patientand inquiring about any medical issues that may have prompted therequest for an examination, the physician can, for example, providehealth instruction information to the patient or local health careassistant. For example, the physician can direct the patient and/or alocal health care assistant to perform diagnostic tests on the patientusing selected diagnostic devices 32 (step 1026). For example, thephysician may direct a local health care assistant to take bloodpressure readings or measure the patients weight. The patient and/orlocal health care assistant can then use one or more diagnostic devicesto generate the patient diagnostic information at step 1028.

As used herein, health instruction information includes any informationreceived from the physician or other health care provider. Healthinstruction information can be generated from physician device 38 andtransmitted to patient device 36 in real-time so that the patient orother health care provider can, administer medication, perform adiagnostic procedure, taking vital signs, manipulate a digitalmicroscope (e.g. digital microscope 62 to a certain region of thepatients body or any other action. In some instances, health instructioninformation may not necessitate any immediate action by the patient. Forexample, the physician may indicate through health instructioninformation that the patient should take their temperature in one hour.However, the health instruction information is transmitted and receivedby the patient in real-time.

Health instruction information can be in the form of voice, text orimage data or any other suitable type of data. For example, when voicedata is the form in which health instruction information is formulated,the voice data can be transmitted to video conferencing server 42. Voicedata can be oral instructions to the patient. When text or image data isthe form in which health instruction information, the text or image datacan be transmitted to the patient records server 40. For example, thephysician can send a message to a patient to “take blood pressure”rather than communicating the instruction orally. Other suitabletechniques for transmitting health instruction information are possible.For example, image data can be sent to video conferencing server 42rather than patient records server 40.

As discussed previously, transmitters in the diagnostic devices 32 canwirelessly transmit patient diagnostic information generated bydiagnostic devices 32 to patient device 36 in association with patientidentification information, for example, a unique alphanumeric codeassigned to the patient (step 1030). The wireless transmission ofdiagnostic data to patient device 36 can be performed using theBluetooth protocol. The patient device 36 can encrypt the receivedpatient diagnostic information and patient identification data, using anhttps protocol or any other secure protocol. Thus encrypted, the patientidentification data and patient diagnostic information can betransmitted to the patient record server 40 (step 1032). Using physiciandevice 38, the physician can access patient record server 40 upon loginusing permissions-assigned passwords for safety and confidentiality andcan retrieve and decrypt the patient diagnostic information which isthen displayed on physician device 38 (step 1034). In certain examples,the patient diagnostic information is also transmitted to the patientdevice 36, where it is decrypted and displayed to the patient. Theconcurrent transmission of patient diagnostic information from patientdevice 36 to physician device 38 while the patient device 36 andphysician device 38 exchange information to conduct a secure videoconference session are in real-time.

In certain situations, the physician may wish to obtain microscopeimages of certain areas of the patient's body. In such situations, thephysician may direct the patient and/or a local health care assistant(such as an emergency room doctor, a nurse, or a physician's assistant)to manipulate digital microscope 62 (or other diagnostic device 32) toselected regions of the patient's body to obtain the desired microscopeimages (step 1036). Digital microscope 62 can transmit video data of theimages to patient device 36 which then encrypts and transmits the videodata to video conference server 42 for subsequent retrieval by thephysician and viewing on the physician device 38. At the outset of thecall or during the call, the treating physician may ask another healthcare provider, such as a specialist, to join the video conference. Thespecialist can access the videoconference server (such as by inputtingan IP address or domain name for the videoconference server into his orher computer terminal). After supplying the appropriate authorizationcredentials (such as a log in and password), the specialist will beconnected to the call.

In step 1038, the physician (alone or in conjunction with a consultantor specialist) communicates therapeutic directions to the patient usingphysician device 38. Alternatively, the physician may consider theinformation provided during the video conference and may conduct asubsequent video conference to provide therapeutic directions. Inanother scenario, the physician may conduct a secure video conferencewith another physician and both physicians may view patient diagnosticinformation from the patient records server 40 to collaborate anddevelop a joint treatment plan. The method of FIG. 8 may be used for thediagnosis and treatment of recurring or non-recurring conditions, and itmay also be used to perform periodic monitoring of patients with chronicconditions, such as diabetes. The method of FIG. 7 is not limited to thetreatment of any one particular condition, and exemplary conditionsinclude diabetes, asthma, hypertension, chronic obstructive pulmonarydisease, and heart failure or any other condition.

Exemplary Application

The following is an exemplary application for transmitting patientdiagnostic information to a remotely located physician who is using ahandheld device such as a mobile phone (e.g. physician device 38). Adiagnostic device (e.g., diagnostic device 32), which isBluetooth-enabled, can wirelessly transmit patient diagnosticinformation to a patient device (e.g., patient device 36), which is alsoBluetooth enabled. The patient device can encrypt and transmit thepatient diagnostic information to a patient information sever such as apatient records server 40. The patient information server records thereceived patient diagnostic information in a patient file and thenre-transmits the data to the patient device and a physician device.Access to the patient diagnostic information can be controlled via a setof administrator permissions and all patient data can be shelled withina secure HIPAA compliant environment to ensure confidentiality of datavia, for example, encrypted HTTPS communication.

A secure videoconference can be conducted between one or more physiciansand a patient in a virtual conference room so that the patient and thephysician can access the diagnostic information in real-time during thevideoconferencing session. After reviewing patient diagnosticinformation, a physician, via his physician device, can initiate avideoconference with the patient and/or one or more additionalphysicians (or other healthcare providers). Each physician can accesshave access to the diagnostic information and be part of thevideoconferencing session via their handheld device. As such, eachphysician can receive the diagnostic information real-time regardless oftheir location and review the diagnostic information to provide healthinstruction information. For example, a physician joining the videoconference such as a specialist may request that that a certaindiagnostic procedure be performed on the patient that was not requestedby the physician who was initially part of the video conference. Arecording server (e.g. patient records server 40) can record all voiceand video data from the conference. The virtual conference rooms can beprovided by a videoconferencing server (e.g., video conferencing server42) that can provide, for example, secure https encryption of all voiceand video data.

Alternatively, as discussed previously, the embodiments of remotepatient device 36, physician device 38, patient records server 40,videoconferencing server 42 and/or remote content manager server 44 (andthe algorithms, methods, instructions etc. stored thereon and/orexecuted thereby) can be implemented in hardware, software, or anycombination thereof including, for example, IP cores, ASICS,programmable logic arrays, quantum or molecular processors, opticalprocessors, programmable logic controllers, microcode, firmware,microcontrollers, servers, microprocessors, digital signal processors orany other suitable circuit. In the claims, the term “processor” shouldbe understood as encompassing any the foregoing devices, either singlyor in combination. The terms “signal” and “data” are usedinterchangeably. Further, portions of remote patient device 36,physician device 38, patient records server 40, videoconferencing server42 and/or remote content manager server 44 do not necessarily have to beimplemented in the same manner.

Further, in one embodiment, for example, remote patient device 36,physician device 38, patient records server 40, videoconferencing server42 or remote content manager server 44 can be implemented using ageneral purpose computer/processor with a computer program that, whenexecuted, carries out any of the respective methods, algorithms and/orinstructions described herein. In addition or alternatively, forexample, a special purpose computer/processor can be utilized which cancontain specialized hardware for carrying out any of the methods,algorithms, or instructions described herein. Other embodiments of thepresent apparatus and methods may optionally in any combination includeadditional features such as: configured for manual or automatic entryand storage of patient diagnostic data in a HIPAA compliant encryptedenvironment; single patient data is selectable for review; singlepatient data may be mergable with multiple patient's data into charts,graphs, reports for examination of patient populations; patient data,video and audio may be connectable and transmittable simultaneously byone of satellite, cellular, LAN, or WIFi in a HIPAA compliant encryptedenvironment; views, transfers and stored images, videos and audio are ina HIPAA compliant encrypted environment; push content to patients,including one of educational videos, health news, health alerts, orprescriptions in a HIPAA compliant encrypted environment; generatedremote prescriptions for delivery to patient in a HIP AA compliantencrypted environment; perform every patient data claim can also beperformed without video utilizing a gateway connection; perform everypatient data claim without a computer utilizing a specialized gatewayconnection; auto-schedule patient appointments within a virtual clinic;place patients in a virtual waiting room prior to a virtual exam; andsimultaneously connect multiple participants in an examinationirrespective of their geographic location in a HIPAA compliant encryptedenvironment.

The gateway can work as data receiver and transmitter, which helps usersor their healthcare providers to manage data easily and remotely. Withthe gateway, healthcare providers can monitor and analyze test resultsremotely and effectively through the connection to the server. Dataresults can be viewed in various formats (HTTP, XML, TCP/IP-, etc.). Thegateway is intended to transmit selected medical information (i.e. bloodglucose, blood pressure, Sp02, body weight, BMI, temperature, and thelike) measured by compatible devices via Bluetooth or other wirelessdevices and transmitted over encrypted network using WAN/LAN or 4GCarrier and the like and combinations thereof.

According to another approach, the present embodiment may also beapplied in an ICU setting as part of an e-ICU Monitoring System.Advances in communications, video displays, monitoring devices andcomputers have made it possible to remotely monitor hundreds ofmonitored patients. In this instance, a medical information systemreceives patient data and information from various sources such asdescribed herein as well as inherent to an ICU and displays from ICUmonitoring system. This system allows combination of a real-time,multi-node telemedicine network and an integrated, patient caremanagement system to enable specially-trained Intensivists to provide24-hour/7-day-per-week patient monitoring and management to multiple,geographically dispersed ICUs from both on-site and remote locations.

A member of the medical team can record observations about a patientusing key words and phrases which can be supplemented with additionaltext for customized notation. Multiple types of patient data can beselectively displayed simultaneously, and to multiple remote users. Thesystem can access stored data according to user-specified formulae tocompute a score or metric which reflects a relationship between variousfactors, each factor being weighted appropriately according to itssignificance as defined in the formula.

This e-ICU system allows a medical information system which displays alltypes of medical information about a patient in a variety of easilyunderstood formats in real-time. The medical devices includingVentilator, infusion pump, ECG, Blood Pressure, Blood Glucose,Thermometer, Weight Scale, Pulse, Spirometer, and the like and transmitsthe information to the interface using Wireless/Bluetooth technology.The data is displayed in readable format to the monitoring screen inreal-time. Alerts can be generated by the application based onparameters for each individual patient and send to assigned team membereither as text or email. Each screen can display data for multiplepatients at a time.

FIG. 9 illustrates data flow according to one approach of the presentembodiments for an e-ICU system and is generally indicated at 900. Inthis approach, cloud 910, as described herein, is communicativelyconnected via connections 916 with a monitor 914 (such as a personalcomputer, a tablet computer, a smartphone and the like and combinationsthereof) accessable to a health care provider. In an ICU 918 setting, apatients 920 peripheral devices (such as a camera, ventilator, bloodpressure monitor, glucose monitor, pulse oximeter, IV infusion pump,ECG, thermometer, weight scale, and the like and combinations thereof)can also be communicately connected to cloud 910 via a wireless router912.

In another approach, the present embodiments can begin with a patientlogging into the system. When system has reviewed the users entercredentials, either by manually entered password, voice activation,facial recognition, thumbprint and the like, the patient may select froma variety of menus. For example, the patient may select the “Clinician”menu from the screen. The patient can then select from a variety ofoptions, such as “Take Your Vitals Now”. In this screen, the user maythen select from a variety of peripheral devices as described herein toactivate. The Patient would then touch the corresponding icon for thetest. The devices can use wireless technology to communicate with thesystem. Patients can use the system to take various prearranged surveys.Surveys can be set be pushed daily, weekly, monthly, etc.

On the clinician's side, a clinician has the option to purchasededicated hardware or can access the “Provider Portal” from any devicewith Internet connectivity. After going to the “Provider Portal” theclinician will also be asked to enter a set of credentials. At somepoint, such as after entering the credentials the user also may be askedto choose a language.

Credentials have varying levels to authenticate what clinician areallowed to view. The system administrator can create and assign roles. Aclinician can then be taken to their patient list. On this screen, thecolors may be used to represent alert/parameters set by the clinician.For example, an Alerts/Parameters tab may be set be a clinician to setvital thresholds which generate the colors on patient page. For example,green can be used to indicate that the patient is good for the day.Yellow can mean that the patient is slightly falling outside ofparameters. Red can mean that the patient has fallen outside ofparameters. And, black can mean that the patient has not uploaded anyvitals for that day. Also, on this screen the clinician may have theability to add notes to each patient. Each note is date and timestamped.

When clicking on a patient's ID, the clinician can be taken to thatpatients dashboard. The most recent uploads for that patient aredisplayed here. By clicking on an overview tab, an overview of all testin graph form of the past, for example, 10 results. The system andapparatus can also sort by date using filters, which can be shown on agraph. By clicking on the graph of each test, the system can drill downto each data upload that is date and time stamped. Further, vitalreports from all patients can be exported by the system to electronicspread sheets. The list of the devices that are deployed to each patientcan also be tracked and can also be exported to spread sheets. A shareinfo tab may also be provided for additional doctors or specialist. Theclinician, the patient, a specialist or additional professional may beallowed to view.

One approach to the present embodiments can include a medicinecompliance feature. This feature delivers personalized medicationreminder notifications—specific to each patient and medication. Thesenotifications can be modified in real-time through algorithms combinedwith predictive analytics to constantly alter the message based on eachpatient's interaction with application. The result is to continuallyreinforce medication adherence with fresh relevant communication.

The medicine compliance feature may provide a menu of standard andcustom reports which include medication usage, adherence, effectiveness,geo location, population management and the like. It is uniquecombination of data algorithms and analytics working with the system tohelp identify medication consumption problems as they happen in realtime. Patients can record medication doses and caretakers are able toreceive alerts via incoming, automated calls when patients appeared tohave missed a dose.

In use, the medicine compliance feature will allow a patient to seetheir daily medication schedule and information on any smart device likephone, smart watch, web etc. about whether they taken a required dose.They will also be able to access medication instructions. Eachmedication reminder notification includes customizable pill images, doseand schedule information. On screen, a patient may have differentoptions to select from, for example:

-   -   Take the medication—(This can send notification to caretaker        that the patient has taken the medicine)    -   Read the medication info—(This option can allow the patient to        read the medication information)    -   Skip the medication—(This option can allow a user to skip the        medication, and also notify to caretaker)    -   Snooze the alarm—(This can set the alarm for the next 10-15        mins, for example, for a reminder)    -   Dismiss the reminder—(Once it is dismissed, it can provide the        information for next schedule)

For example, the medicine compliance the Application can let patientknow what time to take their next scheduled dose and if the patient isscheduled to take a dose within next hour or less, he/she will receivemessage ‘Next dose in 30 mins’ etc. If the time for the last scheduleddose of the day has passed, the application is updated to show whetherthe final dose was ‘Taken’, ‘Missed’ or ‘Skipped’.

FIG. 8 illustrates data flow according to one approach of the presentembodiments and is generally indicated at 800. A private cloud 810 isshown as connectivity point of the components of embodiment 800. Cloudcomputing is a type of Internet based computing. Services, data storageand computer applications can be delivered to a computing device throughthe Internet. Cloud computing relies on sharing computer resourcesrather than having local servers or personal devices handleapplications. System 800, as illustrated, shows the private cloud 810connects to an offsite backup 812, a patient 816 interface device suchas a tablet 814, a medical specialist 820 interface device such as aterminal 818, and a medical care facility, such as a hospital 822. Theconnectivity of the system components by connections 832 are detailedherein, but also include encryption devices 830. As shown in FIG. 8, adoctor/physician 826 can be connected to the system at multiple accesspoints such as interfaces shown of a tablet 824 or smartphone 828 andthe like via connects 834 and 836. It is noted that in preferredembodiments, when doctor 826 signs on to portal (cloud) transmitted datais going though https/ssl encryption, but then also has to pass througha second layer of encryption to get in to the portal and then to thecloud.

FIG. 10 illustrates data flow according to another approach of thepresent embodiments and is generally indicated at 1050. In thisembodiment, the private cloud 1070 is communicatively connected tocomponents of the system via connections 1068 having HTTPS/SSLconnections 1064 and encryption devices 1066 (such as a device soldunder the tradename SONICWALL). Data synchronization applications 1070can be in the data stream. In this embodiment, patient 1052 interactswith various peripheral devices 1054 as described herein, which can haveconnections 1060 via a wireless device, such as one sold under thetradename BLUETOOTH 1056 to connect with a device 1058, which is thenconnected the private cloud 1070 via BLUETOOTH 1056 or cellular device1062 connections. Devices 1058 can include a personal computer, a tabletcomputer, a gateway device, smart phone, and the like and combinationsthereof. It is noted that a gateway device is preferably used when videocapabilities are not provided. FIG. 10 also provides an off-site backup1080, a terminal 1070 for access by a case manager, and a terminalaccess for a health care provider 1082 via a hospital EMR 1084 system.

FIG. 11 illustrates data flow according to another approach of thepresent embodiments and is generally indicated at 1100 for patientmedical compliance applications. In this embodiment, the private cloud1122 is communicatively connected to components of the system viaconnections 1124 having HTTPS/SSL connections 1118 and encryptiondevices 1120 (such as a device sold under the tradename SONICWALL). Datasynchronization applications 1126 can be in the data stream. As shown inthis embodiment, a physician at terminal 1132 can set a dosage for amedication through the cloud 1122. The private cloud then can send apush notification to alert a patient 1102 when to take the medication.The push notification can be received by a patient peripheral device1104, such as a tablet computer 1106, a personal computer 1108, a smartphone 1110, a smart watch 1112, and the like and combinations thereof.It is noted that in the preferred embodiments the smart watch 1112 iscommunicatively connected to a peripheral device using a BLUETOOTH orequivalent type of wireless connection 1116. The peripheral deviceconnected to the private cloud 1122 is connected preferably via acellular connection 1104.

FIG. 13 illustrates data flow according to one approach of the presentembodiments and is generally indicated at 1300 as a Second OpinionPlatform. Specifically, FIGS. 13A, 13B and 13B combine to show aflowchart depicting an exemplary system, method and device for a patientto access a consult and a second opinion consult. These embodiments, canprovide international medical consultations and evaluations remotely andvia a web-based platform.

Generally, in this approach, alongside a clinician, the patient mayregister for an account by entering preliminary information andaccepting terms and conditions on the Second Opinion Platform 1300, andthen receive a confirmation email from the platform to activate theiraccount. Once the patient is logged in, the system can advance through aseries of steps to build a patient profile to output a customeridentification number, and for requesting, for example, a UnitedStates-based second opinion.

Thus, the system is capable of providing virtual care throughout theworld. Select providers can then deliver second opinions to patientsvirtually. The patient and referring physician register the patient inthe Second Opinion Platform, to perform documented HIPAA complaintvirtual consultations and reports. According to one approach,telemedicine carts with the present systems and methods may beimplemented at health care facilities. These telemedicine carts aredesigned to create a direct connection to a medical professional'scomputing system, such as a tablet computer, and to connect with themfrom the patient's home.

By way of example, in one medical emergency, a physician may have a fourhour time period to administer the correct medication to a strokepatient, and all that is needed is a visual assessment to do so. Priorto implementing this type of stroke program, the health care facilitywould need to send out a patient transport, such as an ambulance orhelicopter, to bring stroke patients to the hospital for the specialistto provide a visual assessment. This is time consuming and veryexpensive. Utilizing the present system, health care providers are ableto assess a stroke patient in real-time virtually. The telemedicine cartcan also now perform these services remotely and are able connect andcommunicate via synchronous video conferencing and control thetelemedicine cart remotely by, for example, panning, tilting, andzooming the camera to focus in on the patient at the required level. Theresult of the present system provides greater access to specialists fortheir patients in a quicker timeframe while reducing travel and dollarsspent.

Second Opinion Platform 1300 may have steps such as: assisting thepatient in their understanding and acknowledging the service; providingeducation on how to request the second opinion and the time it takes tocomplete; receiving referring physician information if there is areferring physician; and providing choices so that a patient has theability to choose which type of consultation they desire or need. Next,the system determines, based on the provided information, a request andconsultation process specific to their choice. Choices can include: asynchronous review, an asynchronous review, a pathology review, and anasynchronous and pathology review. Other types of choices andcombinations of choices are possible and the four provided herein areexemplary to illustrate preferred embodiments.

A synchronous review includes real time, for example, a real timeface-to-face interactive video appointment between a patient and hisreferring physician and/or other health care specialist. Request andConsultation steps within the system may include providing the followingto the patient:

-   -   i. The patient selecting which specialist he/she would like        based on a description of the medical doctor and their        specialist.    -   ii. The patient signing a release of information.    -   iii. The patient filing out a Health History questionnaire.    -   iv. The patient providing Initial diagnosis (if any).    -   v. The patient uploading documents pertinent to medical records,        imaging lab results, passport identification, and the like.    -   vi. Confirmation page receipt is given confirming appointment        type, name and specialty of selected MD and initial diagnosis.        Can be printed or emailed.    -   vii. Obtaining payment via credit card or referring physician        through the portal.    -   viii. Scheduling the consultation via an online scheduler.    -   ix. Providing a registration receipt to email or print.    -   x. On the scheduled date of the consultation, the virtual second        opinion consultation takes place. It is expected that a patient        is on-site with their referring physician.    -   xi. Following the consultation, the patient, referring physician        and US-based specialist fill out a quality survey.    -   xii. Within 5 days of the consultation, the, for example,        US-based specialist fills out a report and uploads it to the        portal. Patient and referring physician are notified via email        and can access report of findings.

An asynchronous review includes a medical record review only by thesecond opinion specialist and would not provide real time face-to-faceinteraction. Request and Consultation steps within the system for anasynchronous review may include providing the following to the patient:

-   -   i. Patient selects which specialist he/she would like based on a        description of the MD and their specialty.    -   ii. Patient signs a release of information.    -   iii. Required demographic information is collected.    -   iv. Health History questionnaire is filled out.    -   v. Initial diagnosis is documented (if any).    -   vi. Patient uploads documents pertinent to medical records,        imaging lab results, and passport identification.    -   vii. Confirmation page receipt is given confirming appointment        type, name and specialty of selected MD and initial diagnosis.        Can be printed or emailed.    -   viii. Payment is obtained via credit card or referring physician        through the portal.    -   ix. Customer education for expectations takes place.    -   x. Registration receipt is available to email or print.    -   xi. Within 5 days of the consultation request, the US-based        specialist fills out a report and uploads it to the portal.        Patient and referring physician are notified via email and can        access report of findings.

A pathology review can include previous medical pathology reports anddocumentation as well as patient samples (tissue blocks and/or slides)of body tissue for diagnostic purposes. Request and Consultation stepswithin the system for a pathology review may include providing thefollowing to the patient

-   -   i. Patient prints off a mailing label and packing slip.    -   ii. Patient electronically signs a release of information.    -   iii. Required demographic information is collected.    -   iv. Health History questionnaire is filled out.    -   v. Confirmation page receipt is given confirming appointment        type, name and specialty of selected MD and initial diagnosis.        Can be printed or emailed.    -   vi. Payment is obtained via credit card or referring physician        through the portal.    -   vii. Registration receipt is available to email or print.    -   viii. Within 5 days of receiving the package for pathology        review, the pathologist fills out a report and uploads it to the        portal. Patient and referring physician are notified via email        and can access report of findings.

An asynchronous and pathology review can include previous medicalpathology reports and documentation as well as patient samples (tissueblocks and/or slides) of body tissue for diagnostic purposes and medicalrecord review by a second opinion specialist. This feature of the systemwould NOT include real time face-to-face interaction. Request andConsultation steps within the system for a pathology and asynchronousreview may include providing the following to the patient:

-   -   i. Patient selects which specialist he/she would like based on a        description of the MD (health professional) and their specialty.    -   ii. Patient electronically signs a release of information.    -   iii. Required demographic information is collected.    -   iv. Health History questionnaire is filled out.    -   v. Initial diagnosis is documented (if any).    -   vi. Patient uploads documents pertinent to medical records,        imaging lab results, and passport identification.    -   vii. Confirmation page receipt is given confirming appointment        type, name and specialty of selected MD and initial diagnosis.        Can be printed or emailed.    -   viii. Payment is obtained via credit card or referring physician        through the portal.    -   ix. Customer education for expectations takes place.    -   x. Registration receipt is available to email or print.    -   xi. Within 5 days of the consultation, the second opinion        specialist fills out a report and uploads it to the portal.        Patient and referring physician are notified via email and can        access report of findings.

FIG. 13 represents an embodiment of the present system, methods anddevices that can be deployed including use of a device such as acomputing device or integrated into and as part of a telemedicine cart.The steps below are in a typical order of how a patient would access aconsult. It is noted that this is the preferred order, though otherorders of steps are possible within the scope of the embodiments. Someitems are to be completed upon sign up only (namely steps 1310 (signup), 1312, 1216, 1320 and 1322). The remaining items/steps may becompleted each time a patient requests a second opinion from the secondopinion platform. Note that step 1310 would be for signing into theplatform once the sign up step has been initially completed.

Accordingly, as shown in FIG. 13, the second opinion platform 1300 firstinitiates as a sign up at step 1310. The next steps would be to createan account at step 1312, accepting terms and conditions at step 1314,receive and respond to an activation e-mail at step 1316, signing in atstep 1318, providing customer identification at step 1320, and thenproceeding to account activation, login and customer identificationassignment at step 1322.

Thereafter from the first initiation of the second opinion platform1300, at step 1310 the system would provide the user to just choose signin at step 1310, accept the terms and conditions at step 1314, and besigned in at step 1318, then proceeding to the welcome landing page atstep 1324. Next the user can be moved through an acknowledgement page1326, how to request a telehealth consultation at step 1328, a review ofdocuments requirements at step 1330, referring physician (or otherhealth care professional) information 1332, and from there providingselections from (for exemplary purposes only) four telehealth consulttypes; Pathology Review, Synchronous, Asynchronous; or Asynchronous andPathology Review. It is noted that the illustrated data flow shows whathappens when the user selects one of four consultant types by splittingeach into one of four consultation type columns as follows: PathologyReview 1348, Synchronous 1350; Asynchronous 1352; or Asynchronous andPathology Review 1354. Steps that extend through or across than onecolumn would occur independently in each column but are shown onceacross the columns as an expedient.

If the user selects a Pathology Review 1348 consult, they are providedinstructions to obtain the review in step 1336 then the system proceedsto step 1356. If the user selects a Synchronous 1350 consult they areprovided search options for a pre-approved health care expert in steps1338, 1344 and 1346. Then the system proceeds to step 1356. If the userselects an Asynchronous 1352 consult, they are advanced at 1340 to step1356. If the user selects an Asynchronous consult and a Pathology Review1354 they are provided instructions to obtain the review in step 1342then the system proceeds to step 1356.

Once the user advances past the instructions or decisions from steps1336, 1338, 1344, 1346, 1340 and 1342, irrespective of the chosenconsulting type, the user proceeds through steps 1356, 1358, 1360, 1362,1364, 1366 and 1368 and next picks one of payments at step 1370(facility code) or 1372 (self-pay). Accordingly, the system requires theuser to provide an authorization to treat and a release of informationat step 1356. Next, the system requests required demographic informationat step 1358, health questionnaire information at step 1360, anddiagnosis at step 1362. Next the system prompts the user to uploadpredetermined documentation at step 1364, followed by generating aconfirmation page receipt at step 1366. Next the system moves to apayment method screen at step 1368 and can allow a user to select, forexample, a payment by a facility code 1370 or self-payment at step 1372.

After the user has selected between a payment facility code 1370 orself-payment at step 1372 for a Pathology Review 1348 consult, thesystem can issue the user a registration receipt 1388. As discussedabove, for example, within 5 days of receiving the package for pathologyreview, the pathologist can fill out a report and upload it to thesystem via a portal. The systems generates via email or similarcommunication a notification to the Patient and referring physician toaccess the report of findings.

After the user has selected between a payment facility code 1370 orself-payment at step 1372 for a Synchronous 1350 consult, the user canbe prompted for customer scheduling education at step 1374 followed byscheduling a health professional consultation at step 1376. The systemissues the user a registration receipt 1388.

Next, the system begins the video the synchronous consultation at step1393 as determined in step 1376, followed by entering the consult atstep 1394 at consultation date 1390. Next (FIG. 13C) the system canprovide a synchronous video link between, for example, the consultant,the health care provider and the patient at step 1395. Following thevideo consultation at step 1395, the system can prompt a user tocomplete a quality survey at step 1396 followed by closing the videosession at step 1397. As discussed above, for example, within 5 days ofthe consultation, the second opinion specialists can fill out a reportand upload it to the system via a portal. The systems generates viaemail or similar communication a notification to the user/patient andreferring physician to access the report of findings.

After the user has selected between a payment facility code 1370 orself-payment at step 1372 for an Asynchronous 1352 consult, the user isprompted for customer scheduling education at step 1380. The systemissues the user a registration receipt 1388. As discussed above, forexample, within 5 days of the consultation, the second opinionspecialists can fill out a report and upload it to the system via aportal. The systems generates via email or similar communication anotification to the user/patient and referring physician to access thereport of findings.

After the user has selected between a payment facility code 1370 orself-payment at step 1372 for an Asynchronous consult and PathologyReview consult 1354 consult, the user is prompted for customerscheduling education at step 1384. The system issues the user aregistration receipt 1388. As discussed above, for example, within 5days of the consultation, the second opinion specialists and pathologistcan fill out a report and upload it to the system via a portal. Thesystems generates via email or similar communication a notification tothe Patient and referring physician to access the report of findings.

As described herein, the healthcare providers may provide furtherfollow-up as need for patient care.

FIG. 14 illustrates an exemplary system and platform for use inimplementing methods, techniques, devices, apparatuses, systems,servers, sources and the like, in accordance with some of the presentembodiments detailing input from a patient's biosensors. As illustratedin FIG. 14, one embodiment of this system and platform is generallyindicated at 1420 having a user/patient 1422 communicatively connectedto platform 1420 via at least one biosensor 1426. A biosensor can be asensor that can sense the patient's state in real time or recorded overa period of time or the environment around the patient. Examples ofthese types of sensors can include a patient 1422's temperature, ECG,blood pressure, glucose levels, pulse, activity levels, and the like andany combination thereof. Sensors could also include ambient temperature,time of day, light, humidity, and the like and combinations thereof.

A patient's near field 1424, i.e., an immediate area around the patient,can allow for connectivity with platform 1420 using near fieldcommunications. As an example, Near Field Communication (NFC) is ashort-range wireless connectivity standard (Ecma-340, ISO/IEC 18092)that uses magnetic field induction to enable communication betweendevices when they are touched together, or brought within a fewcentimeters of each other in zone 1424. The standard specifies a way forthe devices to establish a peer-to-peer (P2P) network to exchange data.After the P2P network has been configured, another wirelesscommunication technology, such as Bluetooth, cellular, or Wi-FiConnectivity, can be used for longer range communication or fortransferring larger amounts of data. (See generally,http://searchmobilecomputing.techtarget.com/definition/Near-Field-Communication)

As shown in FIG. 14, an NFC device 1428 and the system NFC reader 1430may be used to connect the biosensor output (and in some embodiments toreceive system output) with the platform 1420. It is noted that whileNFC technology is described herein, other types of wirelesscommunication or even wired communication are possible within the scopeof the present embodiments.

Platform 1420 may have an NFC convertor 1432, which can convert the NFCcommunication into, for example, a wireless technology such as knownunder the trade name BLUETOOTH. It is again noted that while BLUETOOTHtechnology is described herein for this aspect of the presentembodiment, other types of wireless communication or even wiredcommunication are possible within the scope of the present embodiments.It is likewise noted that any device in the embodiments described hereinwould not be limited to specific wireless or wired communications unlessspecifically described as such.

Next the BLUETOOTH communication from the biosensors can be receivedfrom a further device, such as a mobile phone, tablet and the like,which is communicatively connected to a cell tower 1436 or the Internetvia a WI-FI connection 1438. From here the biosensor input (or theoutput to the biosensor) can enter the Internet via variouscommunications protocols, such as HTTPS SSL 1440 then to a SONICWALLencryption level at 1442. It is noted that for purposes of clarity thedata flow is described as shown flowing from the biosensor. It is notedthat data can similarly flow in reverse and generated to be received bythe biosensor or within other components of the systems methods anddevices described herein.

Next the input from the biosensor 1426 can be saved to a platform 1420database, such as an SQL database 1444. Structured Query Language (SQL)is a standard computer language for relational database management anddata manipulation. SQL is used to query, insert, update and modify data.Most relational databases support SQL, which is an added benefit fordatabase administrators (DBAs), as they are often required to supportdatabases across several different platforms. It is noted though thatother types of platforms would be possible. The illustrated SQL databasecan be communicatively be connected to the patient's health careprovider 1466, the patient's case manager 1454, and to the systemsoff-site backup system and device 1448.

As the biosensor 1426 information proceeds from database 1444 to backup1448, it can pass through a sonic wall encryption level 1446.

As the biosensor 1426 information proceeds from database 1444 to healthcare provider 1466, it can pass through a sonic wall encryption level1456 and data synchronization 1458. Next the biosensor data can thenproceed to a hospital EMR 1460, then into the Internet via HTTPS SSLcommunications protocols 1462 to health care professional's computingdevice 1464. Device 1464 can include a personal computer, a tabletcomputer, a gateway device, smart phone, and the like and combinationsthereof.

As the biosensor 1426 information proceeds from database 1444 to thepatient case manager 1454, it can pass through a sonic wall encryptionlevel 1446 and data synchronization 1448, then into the Internet viaHTTPS SSL communications protocols 1450 to case manager's computingdevice 1452. Again, device 1452 can include a personal computer, atablet computer, a gateway device, smart phone, and the like andcombinations thereof.

It is also noted that the present biosensor information may also beintegrated into the other systems, methods and apparatuses to providedwarnings, scheduling and notifications and other features as describedherein.

An optional radiology image viewer application can also be added as partof the features of the present systems, methods and present telemedicineplatform devices. In one exemplary approach, a web based application canbe based on remote or network based real-time access to Digital Imagingand Communications in Medicine (DICOM) images/data files. DICOM is thestandard for the communication and management of medical imaginginformation and related data (e.g., CT Scans, X-rays, MRI, other typesradiology files and the like). Real time collaboration with allapplications described herein can also be configured for manual orautomatic entry and storage of patient diagnostic data in a HIPAAcompliant encrypted environment In the present application. This featureallows for health care providers to collaborate among themselves or withthe patient with real-time DICOM image viewing. This feature can alsooverlay with concurrent videoconferencing feature also included as partof the telemedicine platform. The videoconferencing can include DICOMimage sharing among multiple users' browsers using a cloud based serveror a local machine. In some applications, multiple portals can be openedto allow additional peripheral devices described herein, such ascameras, microphones and the like.

DICOM images can be loaded and viewed remotely by healthcare specialistor patient. Screen shots are shown at FIGS. 15-22 from an exemplaryembodiment of the present application. In FIG. 17 using the“Store/Upload” feature, images may be added. Additional functionality,like measuring, rotation, etc. to the images, can also be provided aswill be described below.

Accordingly, as shown in FIG. 6 above, once the physician'sauthorization to review data for a specific patient is confirmed, theDICOM data can be transmitted in encrypted form to physician device 38.At step 1016, physician device 38 can include executable code (which maybe provided by content manager server 44) to allow for the decrypting ofencrypted patient DICOM information. The patient DICOM information canthen be display on physician device 38 to be viewed by the physician atstep 1018. See also, FIG. 14, Device 1464. Upon access to the system, amedical professional 1466 can see, by way of example, an Icon basedscreen is shown in FIG. 15.

Turning now to the Figures, FIGS. 15-22 show user interface screensaccording to one approach to the present DICOM image viewingapplication.

FIG. 15 illustrates an exemplary Login in screen to access an exemplaryapplication to view DICOM records and the like. Sign in screen 1500allows access to the application with login credentials such as e-mail1510 and Password 1512. A “Forgot Password” option 1514 is alsoprovided. Once the credentials are entered the user may use the “Login”1516 button to access the application.

FIG. 16 illustrates an exemplary default homepage 1600 for theapplication to view DICOM records and the like of FIG. 15 defaulting tothe “Query and Retrieve” tab 1612. Other tabs include a “Store/Upload”tab 1614 and a “Viewer” tab 1616 described below. Under the “Query andRetrieve” tab 1612 a user may enter identifiers to locate a patient'sDICOM images including: Patient ID (system unique identifier, e.g.,social security number) 1618; Patient name 1620; Study date 1622;Study#1624 (Medical series number, Serial number, etc.). The system willperform a search for the identified records by tapping the Searchcommand button 1626. Once the search has been execute, identifiedrecords can be retrieved by Studies 1628 (listing DICOM images by e.g.,affected body part; Series 1630 (all the studies with the series, e.g.,different angles captured and Instances 1632 (e.g., by clicking aseries).

FIG. 17 illustrates an exemplary view for the homepage 1700 of FIG. 16to view DICOM records when the “Store/Upload” tab is selected. Thesystem can anonymize data when shared or uploaded by requiring entry orremoval of the Patient ID and/or the Patient name. Usually the DICOMdata has the patient information as port of its meta-data. See FIG. 18.Accordingly, the screen provides, for example, an Anonymize 1712 featureas to Patient ID 1714 and Patient name 1716. Store 1718 feature allowsoptions to Browse 1720 or Upload 1722 DICOM images.

FIG. 18 illustrates an exemplary view for a homepage 1800 of FIG. 16 toview DICOM records when the “Viewer” tab is selected or when otherroutes to access metadata information related to the DICOM image isrequested by a user. This screen can provide, for example, a DICOM list1812, DICOM hyperlink detail 1814 (such as TAG 1816, TYPE 1818, SIZE1820, VALUE 1822, a scroll bar 1824 and a link 1826 to a specific DICOMimage (DET=detail; 3d=3 dimensional).

FIG. 19 illustrates an exemplary schematic view of a selected DICOMrecord selected from DICOM list of, for example, FIG. 18. A DICOM Viewer1900 can provide image treatment 1912 (such as PAN, length measurements,annotations, angle adjustment, reset to original image, next image, PLAYimages, video, and the like), image stacking options 1914 can beincluded (, stack, scroll, magnify, ROI (Region of Interest) window,Probe, ellipse, rectangle selection, invert and clear) to display DICOMimage 1916.

FIG. 20 an alternate exemplary schematic view of a selected DICOM record2000 selected from DICOM list of FIG. 19 with the ‘Stack Scroll’ buttonis selected. Features of this screen may include: Window Level 2010;Stack (See e.g., FIG. 19) 2012; Series Selection 2014; Scroll bar forimage within series 2016 to affect the display of DICOM image 2018.

FIG. 21 illustrates an alternate exemplary Login in screen 68 a (Cf.,FIGS. 4a and 16) with a graphical user interface screen to access anexemplary applications including an application to view DICOM recordsand the like. As shown, this screen can provide a system toolbar 58;nurse application 58 a; DICOM viewer application 58 b; user home screen68 a and graphical interface button to launch specific application 70a-f.

FIG. 22 illustrates the graphical user interface screen of FIG. 21 whenicon 58 b is selected showing an exemplary schematic view of a selectedDICOM record selected from a patient specific DICOM list.

FIG. 23 illustrates an exemplary schematic of an optional videoconferencing capability within the DICOM viewer application. Thisapplication adds a WebRTC functionality to the DICOM application. WebRTCis a free, open-source code to provide web browsers and mobileapplications real-time communication via application interfaces. Thisfunctionality will add real time communication to the application whichcan allow health care professional to interact in real-time using theDICOM viewer feature. This functionality allows users to share real timeinteractive communication. This WebRTC application can provide real-timecommunication, sharing, screen recording, messaging, etc capabilitiesvia application program interfaces (APIs) to the present Radiology DICOMapplication. Accordingly, multiple doctors can view, edit and providereal time opinion on any given DICOM image or case. This is mostly goingto be backend process, so there won't be special screen shot for it. Wecan discuss more on call if required and explain to you in details.

As shown in FIG. 23, this Video conferencing option for DICOM viewerapplication 2300 options can provide a caller generated screen withDICOM viewer app loaded 2302 and a simultaneous callee generated screenfrom caller screen 2304 connected via server, cloud or local machine(server) 2306. Also this provides data transfer to/from server of caller2308 and data transfer to/from server of callee 2310 to deliver tobrowser 2312 via a session description to caller to share the session2314 and session description to callee to share the session 2316. Thisallows for a caller screen with WebRTC application 2318 and calleescreen 2320 via media transfer 2322 to caller 2324 and callee 2326.

In a general illustration, the present invention can be realized asmethods or systems in hardware, software, or a combination of hardwareand software of a computing device system including a computing devicenetwork system as shown schematically in FIG. 12. The present inventioncan be realized in a centralized fashion in one computing device systemor in a distributed fashion where different elements are spread acrossseveral computing device systems. Any kind of computer system, or otherapparatus adapted for carrying out the methods described herein, issuited.

A typical combination of hardware and software may include a generalpurpose computer system with a computer program that, when being loadedand executed, controls the computer system such that it carries out thesystems and methods described herein. The present invention may bevoluntarily embedded in a computing device program product (or anycomputing device useable medium having computer readable program codeembodied therein), which comprises all the features enabling theimplementation of the methods and systems described herein and whichwhen loaded in a computing device system is able to carry out thesesystems and methods. The present invention may be embedded in acomputing device program product by a manufacturer or vendor of thecomputing device (or any computing device useable medium having computerreadable program code embodied therein), which comprises all thefeatures enabling the implementation of the methods and systemsdescribed herein and which when loaded in a computer system is able tocarry out these systems and methods, and is voluntarily turned off or onby the user. The present invention may be embedded in a computer programproduct by a manufacturer or vendor of the computer (or any computeruseable medium having computer readable program code embodied therein),which comprises all the features enabling the implementation of themethods and systems described herein and which when loaded in a computersystem carries out these systems.

Computer program or computer program product in the present contextmeans any expression, in any language, code or notation, of a set ofinstructions intended to cause a system having an information processingcapability to perform a particular function either directly or aftereither or both of the following: (a) conversion to another language,code or notation, and (b) reproduction in a different material orelectronic form.

Further, the processes, methods, techniques, circuitry, systems,devices, functionality, services, servers, sources and the likedescribed herein may be utilized, implemented and/or run on manydifferent types of devices and/or systems. Referring to FIG. 12, thereis illustrated an exemplary system 700 that may be used for many suchimplementations, in accordance with some embodiments. One or morecomponents of the system 700 may be used for implementing any circuitry,system, functionality, apparatus or device mentioned above or below, orparts of such circuitry, functionality, systems, apparatuses or devices,such as for example any of the above or below mentioned computingdevice, the systems and methods of the present invention, requestprocessing functionality, monitoring functionality, analysisfunctionality, additionally evaluation functionality and/or other suchcircuitry, functionality and/or devices. However, the use of the system700 or any portion thereof is certainly not required.

By way of example, the system 700 may comprise a controller or processormodule, memory 714, and one or more communication links, paths, buses orthe like 718. Some embodiments may include a user interface 716, and/ora power source or supply 740. The controller 712 can be implementedthrough one or more processors, microprocessors, central processingunit, logic, local digital storage, firmware, software, and/or othercontrol hardware and/or software, and may be used to execute or assistin executing the steps of the processes, methods, functionality andtechniques described herein, and control various communications,programs, content, listings, services, interfaces, logging, reporting,etc. Further, in some embodiments, the controller 712 can be part ofcontrol circuitry and/or a control system 710, which may be implementedthrough one or more processors with access to one or more memory 714.The user interface 716 can allow a user to interact with the system 700and receive information through the system. In some instances, the userinterface 716 includes a display 722 and/or one or more user inputs 724,such as a buttons, touch screen, track ball, keyboard, mouse, etc.,which can be part of or wired or wirelessly coupled with the system 700.

Typically, the system 700 further includes one or more communicationinterfaces, ports, transceivers 720 and the like allowing the system 700to communication over a communication bus, a distributed network, alocal network, the Internet, communication link 718, other networks orcommunication channels with other devices and/or other suchcommunications or combinations thereof. Further the transceiver 720 canbe configured for wired, wireless, optical, fiber optical cable or othersuch communication configurations or combinations of suchcommunications. Some embodiments include one or more input/output (I/O)ports 734 that allow one or more devices to couple with the system 700.The I/O ports can be substantially any relevant port or combinations ofports, such as but not limited to USB, Ethernet, or other such ports.

The system 700 comprises an example of a control and/or processor-basedsystem with the controller 712. Again, the controller 712 can beimplemented through one or more processors, controllers, centralprocessing units, logic, software and the like. Further, in someimplementations the controller 712 may provide multiprocessorfunctionality.

The memory 714, which can be accessed by the controller 712, typicallyincludes one or more processor readable and/or computer readable mediaaccessed by at least the controller 712, and can include volatile and/ornonvolatile media, such as RAM, ROM, EEPROM, flash memory and/or othermemory technology. Further, the memory 714 is shown as internal to thesystem 710; however, the memory 714 can be internal, external or acombination of internal and external memory. Similarly, some or all ofthe memory 714 can be internal, external or a combination of internaland external memory of the controller 712. The external memory can besubstantially any relevant memory such as, but not limited to, one ormore of flash memory secure digital (SD) card, universal serial bus(USB) stick or drive, other memory cards, hard drive and other suchmemory or combinations of such memory. The memory 714 can store code,software, executables, scripts, data, content, lists, programming,programs, log or history data, user information and the like.

Some of the present embodiments may be installed on the computing devicethat receives data transaction requests from the computing device froman interface. The present embodiments can be configured to process datatransaction requests received through the interface. Typically, thepresent embodiments can be communicatively connected to a communicationnetwork (e.g., a WAN, LAN, the Internet, etc.), and has the capabilityof completing the data transaction requests. The present embodiments cancommunicationally connect with one or more remote servers that areconfigured to provide information useful in determining the nature ofone or more data transaction requests. The present embodiments canfurther, in some instances, complete a data transaction request throughthe interface.

Further, in some applications, the remote server is implemented throughand/or includes a server cluster containing multiple servers thatcooperatively operate and/or communicate to provide analysisfunctionality. In other instances, the remote server may be implementedin part or fully on personal computer.

The present embodiments may further block access to the network accessactivity when the network access activity is considered an objectionableor non-compliant activity.

Third party recipients can access one or more reports in a variety ofways including, but not limited to, the report or reports beingcommunicated by one or more of the remote servers, the third partyhaving access to the remote server to request report, and other suchmethods. A request for a report can include viewing the report while thethird party has access to the remote server.

In some implementations, monitoring software is installed on thecomputing device 1, and in some embodiments is part of the presentembodiments. Additionally or alternatively, some or all of themonitoring and/or monitoring program is implemented at a remote server.In some applications, the monitoring software can be voluntarilyinstalled on the computing device by a user. In other instances, themonitoring software can be pre-installed on the computing device.

In some embodiments, network access activity can includes, for example,access to one or more of the network activity from a group consisting ofhttp, https, network news transfer protocols, file sharing programs,file transfer protocols, chat room access, peer to peer chats, gameprotocols, downloads of data, and electronic mail activity. The presentembodiments can complete the data transaction request through theinterface. In some implementations, the report can be made accessible bya third party recipient (e.g., via direct access through a server 10,e-mail, periodic reports, text alerts, etc.).

One or more of the embodiments, methods, processes, approaches, and/ortechniques described above or below may be implemented in one or morecomputer programs executable by a processor-based system. By way ofexample, such a processor based system may comprise the processor basedsystem 700, a computer, a server, a smart phone, a smart watch, atablet, a laptop, etc. Such a computer program may be used for executingvarious steps and/or features of the above or below described methods,processes and/or techniques. That is, the computer program may beadapted to cause or configure a processor-based system to execute andachieve the functions and/or functionality described above or below.

As an example, such computer programs may be used for implementing anytype of tool or similar utility that uses any one or more of the aboveor below described embodiments, methods, processes, functionality,approaches, and/or techniques. In some embodiments, program codemodules, loops, subroutines, etc., within the computer program may beused for executing various steps and/or features of the above or belowdescribed methods, processes and/or techniques. In some embodiments, thecomputer program may be stored or embodied on a computer readablestorage or recording medium or media, such as any of the computerreadable storage or recording medium or media described herein.

Accordingly, some embodiments provide a processor or computer programproduct comprising a medium configured to embody a computer program forinput to a processor or computer and a computer program embodied in themedium configured to cause the processor or computer to perform orexecute steps comprising any one or more of the steps involved in anyone or more of the embodiments, methods, processes, functionality,approaches, and/or techniques described herein. For example, someembodiments provide one or more computer-readable storage mediumsstoring one or more computer programs for use with a computersimulation, the one or more computer programs configured to cause acomputer and/or processor based system to execute steps comprising:receiving data through the present embodiments that receives datatransaction requests, from a local computing device on which the presentembodiments are implemented, through an interface; and processing,through the present embodiments, data transaction requests receivedthrough said interface. Some embodiments further comprise completingsaid data transaction requests through the present embodiments that iscommunicatively connected via a wide area network (WAN) to a remoteserver which is communicatively connected to said present embodiments;wherein said remote server is configured to provide information usefulin determining a nature of said data transaction request. Someembodiments additionally or alternatively comprise monitoring networkaccess activity of the local computing device, including networkactivity of applications installed on said local computing device;recording results of monitoring said Internet access activity withinsaid remote server. Additionally, some embodiments further comprisecompleting a data transaction request, by the present embodiments,through an interface. Further, in some instances, the Internet accessactivity can include access to at least one Internet activity from agroup consisting of http, https, network news transfer protocols, filesharing programs, file transfer protocols, chat room access, peer topeer chats, game protocols, downloads of data, and electronic mailactivity.

In some embodiments, systems, apparatuses and methods are providedherein useful to obtain product information through scanning. In someembodiments, a method performed by a circuit and/or one or moreprocessors comprises receiving, through an interface, data transactionrequests from a local computing device on which the present embodimentsare implemented; processing, by the present embodiments, the datatransaction requests received through said interface; and completingsaid data transaction requests through a communication connection with awide area network (WAN).

Some embodiments further comprise providing information to a third partyrecipient through processing functionality and/or programming of thepresent embodiments. Further, some embodiments comprise communicating,through the processing functionality, results of the processing to otherportions of the present embodiments. Additionally or alteratively, someembodiments comprise providing, through the processing functionality,information useful in determining a nature of the data transactionrequest.

Some embodiments further comprise monitoring network access activity ofthe local computing device through monitoring circuitry and/orfunctionality of the present embodiments. In some instances, the networkaccess activity comprises network activity of applications installed onthe local computing device. Further, some embodiments comprise recordingresults of monitoring the network access activity within the processingfunctionality. The network activity comprises, in some embodiments,network activity from one or more of and/or a group consisting of http,https, network news transfer protocols, file sharing programs, filetransfer protocols, chat room access, peer to peer chats, gameprotocols, downloads of data, and electronic mail activity. Further,some embodiments comprise completing the data transaction, by thepresent embodiments, through the interface.

In some embodiments, one or more of the circuitry and/or functionalitymay be implemented external to the present embodiments and/or thepresent embodiments may be implemented through distinct circuitry,processors and/or functionality. For example, in some implementations,the monitoring functionality may reside on the local computing deviceindependent from the present embodiments, and be configured to send andreceive data to the present embodiments. Accordingly, the spirit andscope of the present embodiments is not to be limited to the specificembodiments described.

While the invention has been described in conjunction with specificembodiments, it is evident that many alternatives, modifications andvariations will be apparent to those skilled in the art in light of theforegoing description. Accordingly, the present invention attempts toembrace all such alternatives, modifications and variations that fallwithin the spirit and scope of the appended claims. Throughout thisspecification and the drawings and figures associated with thisspecification, numerical labels of previously shown or discussedfeatures may be reused in another drawing figure to indicate similarfeatures.

I claim:
 1. A method for permitting a second opinion platform as part ofa real-time virtual medical examination using a patient device and atleast one diagnostic device, comprising: assisting a patient in theirunderstanding and acknowledging the service; providing education on howto request the second opinion and the time it takes to complete;receiving referring physician information if there is a referringphysician; and providing choices so that a patient has the ability tochoose which type of consultation they desire or need, wherein thechoices are selected from a list consisting of a synchronous review, anasynchronous review, a pathology review, and an asynchronous andpathology review.
 2. The method of claim 1, wherein the step ofsynchronous consultation review comprises the steps of: the patientselecting which specialist he/she would like based on a description ofthe medical doctor and their specialist; the patient signing a releaseof information; the patient filing out a health history questionnaire;the patient providing Initial diagnosis, if any; the patient uploadingdocuments pertinent to medical records; scheduling the consultation viaan online scheduler with a second opinion specialist; attending theconsultation on the scheduled date wherein the patient is on-site withtheir referring physician and the second opinion specialist is remote;within 5 days of the second opinion specialist providing a report anduploading it to the portal; and notifying the patient and the referringphysician via email of the report.
 3. The method of claim 1, wherein thestep of an asynchronous review comprises the steps of: the patientselecting which specialist he/she would like based on a description ofthe health care professional and their specialty; the patient signing arelease of information; the patient providing predetermined demographicinformation is collected; the patient filling out a health historyquestionnaire; the patient providing an initial diagnosis is documented(if any); the patient uploading pertinent to medical records; providingcustomer education for expectations; a second opinion specialistproviding within 5 days of the request a report of findings; andnotifying the patient and referring physician of the report of findings.4. The method of claim 1, wherein the step of a pathology reviewcomprises the steps of: providing a patient a mailing label and packingslip to mail materials and samples to a pathologist; the patientproviding demographic information; the patient providing a healthhistory questionnaire; within 5 days of receiving the package forpathology review, the pathologist provides a report of findings to thesystem; and notifying the patient and referring physician of the reportof findings.
 5. An apparatus for receiving a real-time patient healthstate using at least one biosensor device, comprising: a memory; atleast one processor configured to execute instructions stored in thememory to: receive a signal generated by the at least one biosensordevice and transmitted from the at least one biosensor device, thesignal including both patient health state information and patientidentification data generated by the at least one biosensor device;transmit over a network to a first remote server at least a portion ofthe patient biosensor information and at least a portion of the patientidentification data; and wherein at least one biosensor device is atleast one of a sensor for patient temperature, ECG, blood pressure,glucose levels, pulse, activity levels, and any combination thereof. 6.The apparatus of claim 5, wherein the signal from the at least onebiosensor device is transmitted to the apparatus via one of a wirelessconnection and a wired connection.
 7. The apparatus of claim 6, whereinthe signal from the at least one diagnostic device is transmitted to thepatient device via one of a wireless connection and a wired connection;and wherein the wireless connection is via a wireless connection basedon a near field communication.
 8. The apparatus of claim 7, wherein theat least one processor is further configured to execute instructionsstored in the memory to: receive, from the at least one biosensor deviceabnormal information; generate at least one of an alert of text, reportand e-mail each alert having a different color scheme in response to thereceived abnormal patient diagnostic information; display the at leastone alert to the patient; and resetting the alert report every 36 hours.9. The apparatus of claim 5, further comprising at least one sensordevice of ambient temperature, time of day, light, humidity, and thelike and combinations thereof.